| NPI | 1225033194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: TX H8107) |
| Additional Taxonomies | 202K00000X Phlebology (Licence: TX H8107) |
| 208600000X Surgery (Licence: CA A049434) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: CA A049434) | |
| 2086S0129X Surgery, Vascular Surgery (Licence: TX H8107) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2019-12-08 |